What’s all the fuss about creatine?

Creatine is getting a lot of attention in the health blogosphere, and is seemingly the new must-have supplement for health and longevity (move over NMN).

But why is it suddenly so popular? Where would you consider using it? And does the evidence stack up?

Firstly, what is creatine?

A lot of people will remember creatine first coming on the scene amongst the gym crowd, where it showed up in pre-workout blends (amongst other substances of questionable efficacy), claiming to enhance muscle activity and recovery. Fast-forward and it turns out there was some truth to these claims.

Creatine is a non-protein amino acid derivative (but not technically an amino acid itself), synthesized from the amino acids arginine, glycine, and methionine. It is also found in animal-based foods (mostly meat and fish).

Its main job is to recycle a compound called ATP (adenosine triphosphate), which is the universal energy source in every cell; cells can’t directly use carbohydrates, protein or fat for energy, they need to be converted to ATP first, which then powers the cell to perform its specific function. ATP provides its energy by splitting apart the bonds joining the adenosine and its three phosphate molecules; in their reduced form they no longer provide energy, so the body either needs to generate new ATP from scratch (a time- and energy-hungry process) OR reassemble the adenosine and phosphate into new ATP. And this is where creatine comes in: it quickly recycles the spent molecules into ATP, which is much more efficient when you’re performing high intensity exercise and need quick energy bursts.

So why all the new buzz about creatine?

A few studies have been released in the last few years demonstrating creatine has some potential benefits outside of the gym. While it’s important to note compared to the overwhelming plethora of research on creatine enhancing exercise output there are very few studies supporting other uses of creatine, the initial research is very promising.

As I mentioned ATP isn’t just used by muscles in exercise, it’s used by every cell in the body to carry out its assigned functions. And what is the most energy-hungry organ in the body? The brain. It churns through 20% of our body’s energy, even though it only accounts for 2% of its weight. So, recent research has focussed on creatine as a treatment for conditions where brain energy production is known to be compromised. This includes depression, impaired cognition (including in conditions such as Parkinson’s and Alzheimer’s) and sleep deprivation. There’s also some preliminary evidence of benefit of conditions of impaired metabolism like type 2 diabetes and high cholesterol.

The strongest evidence is for its adjunctive use in depression, which is extremely exciting given many people experience a very poor response rate to current treatment. Creatine supplementation has been shown to significantly improve the results of antidepressants and cognitive behavioural therapy to enhance and hasten outcomes in patients with depression.

So who might benefit from creatine?

Personally, I often prescribe creatine to patients who need support for-

-          Increasing muscle mass: peri- and postmenopausal women are the big winners here (especially if they’re struggling with brain fog)

-          Poorly controlled depression

-          Patients struggling with cognitive function because of poor sleep (hello new mums!)

-          Other conditions where there is impaired ATP production such as chronic fatigue syndrome, fibromyalgia and type 2 diabetes/NAFLD/high cholesterol (especially if we’re incorporating exercise to enhance metabolic parameters).

Something I’d like to add about creatine - a lot of patients taking it say they don’t know if it’s doing anything. If you’re asking yourself the same question, the answer is it probably isn’t! Not everyone needs to supplement creatine (sorry supplement industry) because we do consume it in our diet (if eating animal protein). So if you’ve added it in but you don’t notice an improvement in mood, mental energy or exercise output and muscle gains, you may not need it. You can definitely play around with the dosing, including a short-term loading program, but if after that you’re still not sure you’re seeing the benefits, try taking a break and see if you feel any different.

If you’re interested in learning more about creatine, including how much to incorporate and which type is best, you can book in with me here